Collier Area Para Transit driver Eddy Campos, center, helps lower Christine Milbin as driver Felix Anton, right, exits his bus after dropping Milbin off for a medical appointment Thursday morning. Rising fuel costs, increasing demand for services, and budget cuts from state and federal sources are straining the county's budget for the paratransit program. Collier County commissioners this past week approved covering a shortfall of $137,270 for the program through Sept. 30, the end of the county's fiscal year. But, dealing with a projected shortfall the following year means potential service cuts. Lexey Swall/Staff

NAPLES - Collier County commissioners recently approved covering a shortfall of $137,270 for the program through Sept. 30, the end of the county's fiscal year.

But next year's budget is rapidly approaching.

Wanda Mayfield doesn't mince words: Raise the fare and she can't get to clinics for crucial medical care or to Wal-Mart for toiletries.

She may be forced to skip meals or be more sparing with toothpaste.

That's how tight she lives. She is far from alone among local residents with mental illnesses, chronic medical conditions, disabilities or the rural poor who depend on Collier County's paratransit program.

"I live on less than $100 a month. I have to buy laundry soap," said Mayfield, 44, who has schizophrenia. "I can spare $10 a month. Sometimes I can't go and have to wait."

Rising fuel costs, increasing demand for services, and stagnant funding from state and federal governments are straining the county's budget for the paratransit program.

Collier County commissioners this past week approved covering a shortfall of $137,270 for the program through Sept. 30, the end of the county's fiscal year. But next year's budget is rapidly approaching and program directors have outlined three scenarios for addressing the deficit.

The catch is that more people are qualifying for Medicaid and for transportation to get to medical care, employment training and social service agencies.

The paratransit program is budgeted for 120,000 riders annually with a $3.6 million budget but the number of riders has gone up to 125,000 and is forecast to hit 133,000 next year.

That means the 2011-12 budget will be short $250,000 for an estimated $3.85 million needed, said Glama Carter, public transit manager for county government.

About $1.3 million is covered by state and federal sources and riders' co-pays contribute about $113,000.

"The reality is 20 percent to 30 percent do not pay; some simply don't have the money," Carter said. "We haven't (turned them away). It is a difficult situation. Some of the people are in critical medical condition. It is difficult to say, ‘We won't take you to your life-saving (treatment). We have been quite lenient."

The county staff may have to become stricter, and even increase co-pays, to sustain the program, she said.

Some communities, including Lee County and soon Sarasota County, have stopped serving Medicaid clients and riders classified as transportation disadvantaged. That means these communities only provide transportation for the disabled, which is required under the federal Americans with Disabilities Act.

The paratransit program is budgeted for 120,000 riders annually with a $3.6 million budget but the number of riders has gone up to 125,000 and is forecast to hit 133,000 next year.

Currently, Medicaid clients in Collier who qualify for transportation pay $1 for each trip and can only use the service for medical purposes. Disabled riders who can't use one of Collier Area Transit's fixed bus routes pay $2 a trip.

The other group of citizens who can qualify are transportation disadvantaged — the rural poor who have no other means of transportation. Their co-pay is based on income and can be up to $6 a trip.

Carter has put together three different plans for raising co-pays and other program changes to help offset the shortfall next budget year. They are:

■ Increasing co-payments for all riders by $1.

■ Eliminating non-emergency Medicaid trips and increasing co-pays by $1 for the disabled and transportation disadvantaged.

■ Eliminating service entirely for both Medicaid clients and the transportation disadvantaged and only serving people with disabilities.

Cutting out non-emergency trips for Medicaid patients would reduce 25,000 trips. It would mean no longer taking sick children for cancer treatments out of the county or taking kidney failure patients to dialysis, Carter said.

The third option of eliminating service to all Medicaid clients and to the transportation disadvantaged would cut out 60,000 rides a year. That step also means giving up serving as the community transportation provider with the state. The county would have to give 90 days' notice in October and the state would have to contract with a private company.

"For passengers, option three would be the most devastating," she said.

Carter will hold public meetings in August for input before the County Commission has to make a decision in September. She believes the commission will fund the program as much as possible and raise the co-pays in some manner.

"I think they will find a happy medium," she said. "I think it will be a combination of both."

Riders are learning they may have to pay more, which will change their way of life since they live on disability income, with families and have few outings in their day-to-day lives.

Medicaid clients in Collier who qualify for transportation pay $1 for each trip and can only use the service for medical purposes.

Disabled riders who can't use one of Collier Area Transit's fixed bus routes pay $2 a trip.

John Economus, 62, who has a mental illness, uses the transit program twice a week with his brother to get to the Sarah Ann Drop-In Center, a place in North Naples for people with severe mental illnesses to gather for activities.

"I won't be able to make it to Sarah Ann and won't be able to get my pills," Economus said.

He and his brother, both on Medicaid, live with their mother and she pays $16 a week for them to ride the mini-buses to and from Sarah Ann. He doesn't know what they will do if the fare goes up.

"I guess stay home or something," he said.

Kathryn-Leib-Hunter, executive director of the National Alliance on Mental Illness (NAMI) in Collier, which runs Sarah Ann, said many clients use the paratransit system to get to the center. For those who don't qualify, NAMI began providing its own pick-up service a few years ago.

"It's critical, a lot of these folks have no access (to transportation)," she said.

Geralyn Poletti, director of community services at the Collier-County David Lawrence Center, said she has clients who couldn't get to the mental health center if their ridership fees go up.

"It would be unfortunate," she said. "We assist clients in completing the applications. I probably sign off on five or six a month, and that's just my program (of) case management."

The paratransit system has a fleet of 20 vehicles and 20 to 25 drivers; the peak hours are mornings for getting riders to medical appointments, including dialysis centers, Carter said. Other stops are to day programs like Sunrise Community Center for people with developmental disabilities.

Mayfield, who lives in a group home in North Naples, said a fare increase would mean cutting back on trips to the health department, David Lawrence and Sarah Ann. She lives on $630 a month in disability but $500 of that goes to rent.

"I'm not going to be able to afford it. I don't drive and I can't afford to have people drive me," she said. "It's just too much."